Many people would like to know what insurance coverage, if any, they might be able to access when seeing one of our providers. So here’s the information that we explain to all of our patients.
First of all, no matter what type of insurance you have, your insurance will frequently be able to cover all or a majority of your lab work. Labs written from providers at Leigh Ann Scott, M.D. are typically covered the same as if they were written by your regular doctor which is 90 to 100%. You should however ask your insurance company how they cover the labs and which lab network is preferred. We will make sure that any labs ordered are done through this preferred provider.
If your insurance provider does not offer to cover a majority of the lab work or if it is being applied to your deductible we recommend that you use our discount program that we offer through Quest Diagnostics.
In terms of your office visit with the doctor or nurse practitioner, we are an out of network provider. The reason for this is that when a practice chooses to accept insurance, insurance companies tell the practice how much time they can spend with each patient, what illnesses and conditions they can treat, and how they can treat it. In order to get to the root cause of the problem and provide optimal treatment we find we need more time with our patients and more treatment options than insurance companies are willing to work with.
If you have a PPO plan, very often insurance companies will reimburse you for much of your office visit costs. You will pay for the appointments at the time of service and we will provide you with the necessary papers to file for reimbursement with your insurance provider.
If you are on an HMO plan, most likely your insurance will not cover any of the costs of your office visits, but will likely cover all or a majority of your lab work.
To find out what your insurance will cover we encourage you to call the customer service number on the back of your insurance card and ask a few basic questions. First of all tell them that you’re going to see an out of network provider. This means someone that is not on the insurance list of doctors. That said most PPO plans understand that people would prefer to see a doctor that they researched or that comes highly recommended from a friend. Ask your insurance company what the deductible is and what percent they will reimburse for the office visit with an out of network doctor or nurse practitioner.
When talking to your insurance customer service, tell them that your out of network provider is going to order very comprehensive lab work. Ask them specifically what percentage of the lab costs they will pay. If it is 90-100% you are better off to use your insurance. If they will cover less than 75% you will be better off to use our self-pay discount program available through Quest Diagnostics.
